Provider Demographics
NPI:1700876489
Name:PURDUE UNIVERSITY
Entity type:Organization
Organization Name:PURDUE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HIPAA PRIVACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL-ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:765-496-9059
Mailing Address - Street 1:575 STADIUM MALL DR
Mailing Address - Street 2:HEINE PHARMACY BLDG ROOM 118
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47907-2091
Mailing Address - Country:US
Mailing Address - Phone:765-496-7728
Mailing Address - Fax:765-496-6094
Practice Address - Street 1:575 STADIUM MALL DR
Practice Address - Street 2:HEINE PHARMACY BLDG ROOM 118
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47907-2091
Practice Address - Country:US
Practice Address - Phone:765-496-7728
Practice Address - Fax:765-496-6094
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PURDUE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-25
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60000341A333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN60000341AOtherHEALTH PROFESSIONS BUREAU
1514618OtherNABP